"If negotiations are not successful, our doctors, nurses and community will occupy Palm Drive Hospital," Gude states in a one-page flier that he is now circulating.

Dawson called distribution of the flier "unfortunate," adding that members of the foundation said they were unaware of it before Gude started circulating it.

"I hope that doesn't happen," Dawson said, referring to a forced staff takeover of the hospital. "It's not the sort of thing that's good for anybody."

Dawson described talks with the foundation as encouraging and said the board would continue negotiations over its proposal. But he said more deliberation is required to ensure the proposal passes muster with state public health officials.

"If we shut it down we have a period of time to do a more meaningful analysis of a plan to move forward," he said.

On Friday, Gude defended his promise of civil disobedience. He said the foundation's plan is solid and would work if given a chance.

"We're taking the hospital space and using it for needed west county medical services," Gude said. "There's criticism that I may jeopardize the cause by making this threat. But it's not a threat. If it closes, it's like closing the thread of life."

Gude said the foundation proposal, which he helped craft, would dramatically reduce the size of the 35-bed medical surgical unit to only five beds to reduce the burden of running the costly department.

Other services that Gude and other local doctors are proposing include: a west county neurology institute featuring a memory clinic; a women's wellness clinic; a urology clinic; an orthopedic clinic and a possible dental clinic.

"It's given that the emergency room stays open 24/7 because that's what the community has repeatedly asked for," Gude said Friday.

The two fixed beds in the ICU would remain open. A previous plan would have converted three hallway ICU beds into ward beds, but Gude said state public health officials told him the medical surgical beds must be located in a hospital ward.

Hospital officials and several board members, including Nancy Dobbs, have argued that plans to save the perennially struggling hospital have failed repeatedly over the years. Officials say too few west Sonoma County residents use the hospital and its overnight patient census has dwindled to the point it cannot be sustained.